Changes On A World Level

Most of us probably know the DSM (Diagnostic and Statistical Manual of Mental Disorders) is but many of us don’t know about the ICD (International Classification of Diseases), this is what the World Health Organization (WHO) has to say about the ICD

History of ICD
The first international classification edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.

WHO was entrusted with the ICD at its creation in 1948 and published the 6th version, ICD-6, that incorporated morbidity for the first time. The WHO Nomenclature Regulations, adopted in 1967, stipulated that Member States use the most current ICD revision for mortality and morbidity statistics. The ICD has been revised and published in a series of editions to reflect advances in health and medical science over time.

ICD-10 was endorsed in May 1990 by the Forty-third World Health Assembly. It is cited in more than 20,000 scientific articles and used by more than 100 countries around the world.

ICD purpose and uses
ICD is the foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions. It is the diagnostic classification standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for:

• easy storage, retrieval and analysis of health information for evidenced-based decision-making;
• sharing and comparing health information between hospitals, regions, settings and countries; and
• data comparisons in the same location across different time periods.

Uses include monitoring of the incidence and prevalence of diseases, observing reimbursements and resource allocation trends, and keeping track of safety and quality guidelines. They also include the counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status, and external causes of disease.

And now it is being updated again to the ICD-11 and it looks like that we are finally are finally going to be taken of the ICD-11 as a mental disorder.

W.H.O. Weighs Dropping Transgender Identity From List of Mental Disorders
New York Times
By Pam Belluck
July 26, 2016

The World Health Organization is moving toward declassifying transgender identity as a mental disorder in its global list of medical conditions, with a new study lending additional support to a proposal that would delete the decades-old designation.

The change, which has so far been approved by each committee that has considered it, is under review for the next edition of the W.H.O. codebook, which classifies diseases and influences the treatment of patients worldwide.

“The intention is to reduce barriers to care,” said Geoffrey Reed, a psychologist who is coordinating the mental health and behavior disorders section in the upcoming edition of the codebook, called the International Classification of Diseases, or I.C.D.
[…]
“It’s sending a very strong message that the rest of the world is no longer considering it a mental disorder,” said Dr. Michael First, a professor of clinical psychiatry at Columbia University and the chief technical consultant to the new edition of the codebook, which is known by its initials and the edition number I.C.D.-11. “One of the benefits of moving it out of the mental disorder section is trying to reduce stigma.”

Other parts of the proposed change are stirring debate, however. The proposal would not take transgender out of the codebook altogether, but would move it into a newly created category: “Conditions related to sexual health.”

Many, but not all, advocates favor the idea of keeping transgender in the codebook in some form because the designations are widely used for billing and insurance coverage of medical services and for conducting research on diseases and treatments. But where should it go?

My thoughts are that it has to be listed as a sexual health issue because I need to get my hormones and healthcare. If it is removed all together there will be no justification for us to get insurance coverage.

You have to understand that the purpose of the DSM and the ICD is for the doctors and therapists to get paid, they look up the diagnostic criteria that best fits their client and then bills the insurance company using the DSM or the ICD codes.

This change is coming about because of research that was done in Mexico.

The Lancet Psychiatry: First field trial supports removing transgender diagnosis from mental disorders chapter within WHO classification
Eureka Alert: American Association for the Advancement of Science
The Lancet
July 26, 2016

New evidence suggests that it would be appropriate to remove the diagnosis of transgender from its current classification as a mental disorder, according to a study conducted in Mexico City. The study is the first field trial to evaluate a proposed change to the place of the diagnosis within the WHO International Classification of Diseases (ICD).

The research, published in The Lancet Psychiatry journal today and led by the National Institute of Psychiatry Ramón de le Fuente Muñiz, involved interviewing 250 transgender people and found that distress and dysfunction were more strongly predicted by experiences of social rejection and violence than by gender incongruence itself. The study is the first of several field trials and is currently being replicated in Brazil, France, India, Lebanon and South Africa.

"Stigma associated with both mental disorder and transgender identity has contributed to the precarious legal status, human rights violations and barriers to appropriate care among transgender people," says senior author Professor Geoffrey Reed, National Autonomous University of Mexico. "The definition of transgender identity as a mental disorder has been misused to justify denial of health care and contributed to the perception that transgender people must be treated by psychiatric specialists, creating barriers to health care services. The definition has even been misused by some governments to deny self-determination and decision-making authority to transgender people in matters ranging from changing legal documents to child custody and reproduction." [1]

"Our findings support the idea that distress and dysfunction may be the result of stigmatization and maltreatment, rather than integral aspects of transgender identity," says lead investigator Dr Rebeca Robles, Mexican National Institute of Psychiatry. "The next step is to confirm this in further studies in different countries, ahead of the approval of the WHO revision to International Classification of Diseases in 2018." [1]

So this is very important for us to be removed out of the section of “mental disorders” to the section on sexual health. Now if only the DSM will follow suit.

[1] Quote direct from authors and cannot be found in text of Article.